- Top charities
The Against Malaria Foundation (AMF) was one of our top-rated organizations from 2009 to 2013 and has received over $10.6 million due to GiveWell's recommendation. In late 2013, we removed AMF from our top-rated list because we felt it had limited room for more funding (more).
Published: November 2012; Updated: November 2013
Does it work? There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity.
What do you get for your dollar? We estimate that it costs $5.80-$6.15 per net distributed by AMF. The numbers of malaria cases prevented and lives saved are a function of a number of difficult to estimate factors, which we discuss in detail below.
Room for more funds? AMF has struggled to come to agreements with countries for net distributions. As of November 2013, it has spent only a small portion of the funds it received in the previous two years. We do not plan to recommend more donations to AMF until and unless it commits the bulk of its current funds to net distributions.
We began reviewing AMF in 2009. Our review has consisted of:
All content on Against Malaria Foundation, including past reviews, updates, blog posts and conversation notes, is available here.
Prior to November 2011, AMF contributed LLINs to small-scale distributions. Since then, it has de-emphasized small-scale distributions and it expects larger-scale distributions to be the primary way in which it distributes LLINs in the future (more below).
AMF has conducted one large-scale distribution in conjunction with Concern Universal in Malawi, which took place in December 2011-March 2012. For details on the Concern Universal distribution, see our March 2012 and September 2012 updates.
In the case of its distribution in Malawi, AMF received estimates of country-level gaps from the Alliance for Malaria Prevention (AMP) and from the Malawi National Malaria Control Program (NMCP). Rob Mather, AMF's founder told us that, although AMF did not have a high level of confidence in the net gap numbers presented by the NMCP, nor those it was sent by the Global Fund, it did have a high level of confidence that the net gap was significantly higher than the 250,000 LLINs AMF was considering providing.3 Note that the materials AMF has sent us from the period prior to its decision to enter Malawi do not include quantified estimates of Malawi's LLIN gap,4 though they do make it clear that there is a gap,5 and later reports (from after AMF had decided on Malawi) show a quantified gap for the country.6
Before deciding to work with Concern Universal in Malawi, AMF requested a distribution proposal, including information on malaria risk in the distribution area (including data on reported malaria cases), other net distributions in the area, coordination with government, and how the distribution would be carried out.13 In addition to working with Concern Universal in Malawi, AMF has had discussions with Plan in Mali and Togo about potential future distributions (see our September 2012 update for further details.)
In order for AMF to partner with an organization, the organization must agree to the following requirements:
AMF looks for partners who, in addition to agreeing to the above requirements, are clear and responsive in their communication with AMF.
Partners must be able to procure funds to cover all non-net costs of the distribution.21 We have expressed to AMF that we are concerned that, by requiring partners to pay for the non-net costs of the distribution, it may limit its capacity to distribute nets. AMF was receptive to the possibility of funding non-net costs in the future, if it believes that doing so would increase its ability to distribute LLINs quickly.22 AMF also told us: "a) in over six years of conducting distributions of some 1.5 million nets there has never been a problem with distribution partners securing funding for non-net costs; b) this may or may not change with larger scale distributions."23
On a separate page, we discuss the general evidence behind distribution of LLINs. We conclude that there is strong evidence that these distributions can be expected to reduce child mortality and malaria cases.
When evaluating the effectiveness of an LLIN distribution organization, we seek to answer the following questions:
AMF requires that distribution partners conduct pre-distribution surveys (if recent, reliable survey data are not available) to determine the number of existing LLINs with at least one year of remaining use and the number of nets required in each household.24 This process includes door-to-door surveys of every household in the targeted district by government health workers, followed by village meetings in which staff of AMF's distribution partner read off household names and the number of LLINs that have been allocated to each household; households then indicate if any errors have been made. We observed one such village verification meeting during our visit to Malawi in October 2011.25
Concern Universal conducted a pre-distribution survey, and shared the full results from the survey.26 Based on GiveWell's suggestion, AMF's distribution partner also decided to send its staff to random households at this stage to spot-check the accuracy of its data.27 After the first two weeks of spot checks, the distribution partner reported that it had not found any discrepancies between the number of nets community members said they needed during the verification meeting, and the number of nets found to be needed during the subsequent household visit.28
We believe it is possible that some households may over-report the number of LLINs they need. Cases of households hiding nets in order to receive extra LLINs have been observed in universal campaigns in Senegal and Nigeria.29 That said, we believe that the steps AMF and its partners are taking to minimize the ability of community members to request more nets than they need are reasonable. We will look for the same approach in future AMF distributions, and will request details of how nets were allocated at the household level.
In Malawi, household surveys conducted by the National Malaria Control Programme (in districts not receiving AMF LLINs) have found "much larger LLIN gaps than first thought,"30 and it is not clear to us what the cause of this discrepancy is. We will seek more information when available to assess what this indicates about ensuring nets are accurately distributed and used in large-scale distributions.
AMF requires that partners send photos and videos of distributions.31 As of November 2012, Concern Universal has provided photos and/or videos for all but 1 of the 14 “sublocations” in Malawi in which it had distributed LLINs earlier that year.32 As we report in our March 2012 update, there were a number of issues that arose during Concern Universal’s distribution in Malawi, which were reported in its weekly updates during the distribution, including attempted thefts, double registrations and logistical problems.33 Overall, Concern Universal seemed to be aware of potential problems and had a system in place to address them.34
At the highest level, AMF appears to exclusively target countries with known malaria risk.35 In its distribution proposal for AMF, Concern Universal reported the number of malaria cases in the proposed distribution are over a twelve month period (June 2010 to July 2011).36
In the past, AMF required partners to conduct follow-up surveys at 6, 18, 30 and 42 months after the distribution to assess net condition and whether nets are hung and used correctly. It now requires partners to conduct follow-up surveys at 6-month intervals, and for a period of 3-4 years.37 Following the distribution in Malawi, AMF reported that Concern Universal visited 6% of households in its distribution area 6 months after the distribution.38 The survey found a 90% usage rate.39 In general, surveys from mass LLIN distributions in other countries have found usage rates of 60-80%. (For more, see our page on mass LLIN distributions.)
District by district data is available on AMF's website at http://www.againstmalaria.com/SurveyForms_JobsSummary.aspx (archived). See our September 2012 update for further details.
We do not have information on long-term usage rates for LLINs distributed in large-scale AMF distributions, the first of which was conducted in December 2011-March 2012.
For the distribution in Malawi, AMF received data from the National Malaria Control Program on population figures and LLINs already distributed by district, as well as LLINs that had been committed to the country by other funders. AMF estimated, in September 2011, that an additional 909,586 nets were needed to achieve universal coverage,40 of which AMF contributed 268,240.41
The best estimate we have for the cost to purchase and distribute an LLIN is $5.80.45 To estimate the full cost to purchase and distribute an AMF LLIN, we add AMF's costs in the UK to this figure. Assuming AMF distributes 1 million nets per year, we estimate that AMF's general costs will be about $0.33 per net.46 In total, we estimate that each LLIN purchased by AMF costs about $6.13 to purchase and deliver.
This estimate does not take into account costs of AMF's additional monitoring requirements. We do not have a good estimate of these costs.
Note that we prefer to include all costs incurred to carry out a project, not just those that the charity in question pays for itself. We believe that this gives the best view of what it costs to achieve a particular impact (such as saving a life), and also avoids the lack of clarity and complications of leverage in charity. Our estimate of the cost to distribute an AMF LLIN aims to both costs AMF pays and costs paid by others.
Using $6.13 as the total cost per net, we estimate the cost per child life saved through an AMF LLIN distribution at about $3,400.47
This does not include other potential benefits of LLINs (non-fatal cases of malaria prevented, prevention of deaths in age groups other than under-5 year olds, prevention of other mosquito-borne diseases, etc.). Full details at our report on mass distribution of LLINs.
As a general note on the limitations to this kind of cost-effectiveness analysis, we believe that cost-effectiveness estimates such as these should not be taken literally, due to the significant uncertainty around them. We provide these estimates (a) for comparative purposes and (b) because working on them helps us ensure that we are thinking through as many of the relevant issues as possible.
Since naming AMF as our #1 charity in late 2011, we have tracked over $10.6 million in donations made to it as a result of our recommendation. In that time, AMF has held the funds while attempting to negotiate a net distribution to spend them on. As of November 2013, it has not finalized a distribution large enough to spend the bulk of these funds48 (though it has funded a smaller-scale (~$1 million) distribution in Malawi49).
AMF’s past distributions have been relatively small in scale, compared to the types of distributions it is looking at as of November 2013. To find a sufficiently large distribution requires negotiating with the national malaria control programs of countries in sub-Saharan Africa, which we perceive to have some discretion in which funders they work with, and which we perceive to be choosing funders based on a variety of factors including size and reporting requirements. Because AMF is able to fund only a relatively small piece of a given country’s distribution, but has substantial reporting requirements, there may be fundamental reasons for governments to prefer other funders. We believe that this is the most important and fundamental explanation. We also believe that other factors may have also played a role. We discuss this topic in detail in this blog post.
As of November 2013, we do not plan to recommend more donations to AMF until and unless it commits the bulk of its current funds to net distributions.
We believe the Against Malaria Foundation to be an exceptionally strong and effective organization:
However, we see some potential room for improvement:
More on how we think about evaluating organizations at our 2012 blog post.
Some of AMF's measures for collecting information on key questions are relatively new. We believe that AMF has a strong track record on ensuring that nets are delivered, and on general transparency, and we find its commitment to improving its documentation credible; but it does not have a robust track record on the answers to some key questions, particularly (a) whether individuals' needs for nets are accurately determined and (b) whether people use their nets properly over the long run.
As of November 2013, AMF has been unable to spend the majority of funds it has received due to GiveWell's recommendation.
|Against Malaria Foundation Audited financial statement (2005)||Source|
|Against Malaria Foundation Audited financial statement (2006)||Source|
|Against Malaria Foundation Audited financial statement (2007)||Source|
|Against Malaria Foundation Audited financial statement (2008)||Source|
|Against Malaria Foundation Audited financial statement (2009)||Source|
|Against Malaria Foundation Audited financial statement (2010)||Source|
|Against Malaria Foundation Audited financial statement (2011)||Source|
|Against Malaria Foundation Audited financial statement (2012)||Source|
|Against Malaria Foundation Blog||Source (archive)|
|Against Malaria Foundation Cape Verde summary: Rejected||Source|
|Against Malaria Foundation Concern Universal, Ntcheu, Malawi Distribution||Source|
|Against Malaria Foundation Countries involved||Source (archive)|
|Against Malaria Foundation Decision making||Source (archive)|
|Against Malaria Foundation Dedza and Ntcheu Districts, Malawi||Source (archive)|
|Against Malaria Foundation Distribution proposals: Examples of responses from Malaria Advisory Group (MAG) and follow up with proposers||Source|
|Against Malaria Foundation Distribution proposals: Fully funded examples (June 2010)||Source|
|Against Malaria Foundation Distributions||Source (archive)|
|Against Malaria Foundation DP151: MAG comments||Source|
|Against Malaria Foundation DP171: MAG comments||Source|
|Against Malaria Foundation Financial information (as of November 16, 2012)||Source (archive)|
|Against Malaria Foundation Frequently Asked Questions||Source (archive)|
|Against Malaria Foundation Future distributions||Source (archive)|
|Against Malaria Foundation How we work with distribution partners||Source|
|Against Malaria Foundation LLIN distribution proposal form||Source|
|Against Malaria Foundation Madagascar summary: Rejected||Source|
|Against Malaria Foundation MAG notes on fully funded proposals (June 2010)||Source|
|Against Malaria Foundation MAG notes on proposals that could only be partially funded due to funding constraints (June 2010)||Source|
|Against Malaria Foundation Malaria Advisory Group||Source (archive)|
|Against Malaria Foundation Malawi universal coverage calculations (September 26, 2011)||Source|
|Against Malaria Foundation Net cost for GiveWell updated||Source|
|Against Malaria Foundation Nsambe, Neno District, Malawi||Source (archive)|
|Against Malaria Foundation Ntcheu update (November 2012)||Source (archive)|
|Against Malaria Foundation Post distribution survey: Singo Village, Malawi (6 month survey)||Source|
|Against Malaria Foundation Post-distribution survey example||Source|
|Against Malaria Foundation Proposals that could only be partially funded due to funding constraints (June 2010)||Source|
|Against Malaria Foundation Room for more funding analysis (September 2011)||Source|
|Against Malaria Foundation Why US$5 per net?||Source (archive)|
|All For Children Inc. Pre-distribution beneficiary list for Chepsire, Kapsabet, Nandi East District, Kenya||Source|
|Alliance for Malaria Prevention Conference call minutes||Source (archive)|
|Alliance for Malaria Prevention Conference call minutes (June 22, 2011)||Source|
|Alliance for Malaria Prevention Conference call minutes (November 7, 2012)||Source|
|Alliance for Malaria Prevention Conference call minutes (October 26, 2011)||Source|
|Alliance for Malaria Prevention Toolkit (version 2.0) - Chapter 3||Source|
|Anonymous AMF partner, phone conversation with GiveWell, June 25, 2009||Unpublished|
|Ari Johnson, Project Muso Ladamunen Co-Executive Director, email to Rob Mather, June 6, 2011||Source|
|Charity Commission. The Against Malaria Foundation||Source (archive)|
|Concern Universal Distribution proposal for Ntcheu district (October 2011-February 2012)||Source|
|Concern Universal Pre-distribution registration survey data||Source|
|Concern Universal, Concern Universal costs updated||Source|
|GiveWell AMF distributions||Source|
|GiveWell AMF financial data||Source|
|GiveWell AMF Update (March 2012)||Source|
|GiveWell Cost-effectiveness analysis for LLIN distributions updated||Source|
|GiveWell Notes from meeting regarding LLIN distribution in Malawi (October 21, 2011)||Source|
|GiveWell Notes from site visit with Concern Universal in Malawi (October 2011)||Source|
|Lawson, Todd, and Christina Tottle. 2008. Uganda: Against Malaria Foundation. Field report||Source|
|Malaria Atlas Project Endemic countries||Source (archive)|
|Malaria Atlas Project Homepage||Source (archive)|
|Malaria Atlas Project MAP team||Source (archive)|
|Malawi Ministry of Health. National malaria indicators survey (2010)||Source|
|Melanie Renshaw, African Leaders Malaria Alliance Chief Technical Advisor, email to Rob Mather, June 26, 2011||Unpublished|
|Melanie Renshaw, phone conversation with GiveWell, October 17, 2013||Source|
|Nonprofit Staffing New York Salary Survey Report 2011||Source|
|Noor, Abdisalan et al. 2009. The use of insecticide treated nets by age: Implications for universal coverage in Africa. BMC Public Health 9:369||Source|
|Project Muso. Bednet survey data||Source|
|Project Muso. Bednet survey data summary||Source|
|Rob Mather, Against Malaria Foundation Founder, email to Emily Brotman, November 8, 2011||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, August 6, 2011||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, August 8, 2012||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, June 23, 2010||Source|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, June 24, 2011||Source|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, June 29, 2011||Source|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 16, 2012||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 2, 2011||Source|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 20, 2012||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 21, 2011||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 24, 2011||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 7, 2011||Source|
|Rob Mather, Against Malaria Foundation Founder, email to GiveWell, October 11, 2011||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, phone conversation with GiveWell, April 28, 2009||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, phone conversation with GiveWell, February 11, 2011||Source|
|Rob Mather, Against Malaria Foundation Founder, phone conversation with GiveWell, July 19, 2012||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, phone conversation with GiveWell, March 16, 2011||Source|
|Rob Mather, Against Malaria Foundation Founder, phone conversation with GiveWell, May 11, 2012||Unpublished|
|Rob Mather, Against Malaria Foundation Founder, phone conversation with GiveWell, November 18, 2011||Unpublished|
|Robin Todd, Concern Universal Malawi Director, email to GiveWell, April 27, 2012||Unpublished|
|Robin Todd, Concern Universal Malawi Director, email to GiveWell, April 3, 2012||Unpublished|
|Robin Todd, Concern Universal Malawi Director, email to GiveWell, March 25, 2012||Unpublished|
|Robin Todd, Concern Universal Malawi Director, email to GiveWell, March 30, 2012||Unpublished|
|Robin Todd, Concern Universal Malawi Director, email to Rob Mather, November 18, 2011||Unpublished|
|Robin Todd, Concern Universal Malawi Director, phone Conversation with GiveWell, March 20, 2012||Unpublished|
|St. Luke's Hospital. Post-distribution report for mosquito net distribution||Source|
|St. Luke's Hospital. Questionnaire for net assessment||Source|
|St. Luke's Hospital. Supervision data||Source|
|St. Nicholas Parish Church. Immediate report: Singo Village, Malawi||Source|
|Tossa Kokou, National Program Manager of the National Malaria Control Program, Togo, email to Rob Mather, May 15, 2012||Unpublished|
"How will the money raised be spent? On bednets (mosquito nets). Specifically, long-lasting insecticidal nets (LLINs)." Against Malaria Foundation Frequently Asked Questions.
"This is a list of the countries with known gaps and where there are significant contiguous areas without nets, or a significant percentage required, and for which the estimate of need is believed to be reasonably accurate. It does not include countries where there are gaps, typically up to 40% of what the nation needs, but they are spread more uniformly across the country and would therefore require an ‘in-fill campaign’. An in-fill campaign is different from a so-called ‘universal coverage campaign’ because the percentage installed base of nets is higher in the former case and so a pre-distribution registration survey (PDRS) is an absolute requirement to ensure an efficient allocation of nets. Our methodology would lend itself to these campaigns if the relevant National Malaria Control Programme (NMCP) were to embrace a detailed PDRS. The list does not include, in our view, other countries where the need has not yet been quantified. Given there are many countries with needs estimated, we have not chosen to seek out other countries in need of nets. Our assumption is groups like AMP will be a source of reporting on additional countries as quantified needs emerge." Rob Mather, Against Malaria Foundation Founder, email to GiveWell, August 8, 2012.
"Initial (directional) information
a) Sources of collated numbers (eg AMP, ALMA)
We liaise with groups that collate statistics on net numbers. AMP’s (Alliance for Malaria Prevention) weekly email is one such source as you correctly identify and ALMA’s (African Leaders Malaria Alliance) monthly update is another. The numbers are not always up to date and do not always agree. However they are useful as a first alert that there is a gap in a national campaign. I have attached two emails that show you the sort of thing we receive. b) Distribution Partners Groups involved in distributions in particular countries may be the first to be aware there is a net gap and they may approach us by email or telephone. c) Individuals/Advisors (to national campaigns). Those involved in national campaigns have also approached us in the past to ask if we are in a position to help close a net gap. This may be a technical malaria advisor who has just come out of a meeting where it has become apparent there is a gap in funding for nets for a near-term program. We refer to this information as ‘directional’ as in all cases detailed information is then required to confirm there is a gap." Rob Mather, Against Malaria Foundation Founder, email to GiveWell, June 29, 2011.
"GiveWell: Neither of the AMP emails you sent (May 28, 2011 and June 22, 2011) nor the ALMA email (from June 26, 2011) provide a figure for net gap in Malawi. Do you know why this is? Did you use these groups for directional information in the case of Malawi? Has the net situation changed in Malawi recently?
AMF: I thought it did – about 500,000 nets. However, a number we needed further proof on as our assessment was these were indicative numbers and not hard and fast numbers. We needed hard and fast numbers to be able to commit funds for nets as we would not do so if there wasn’t a gap. Liaising with the Global Fund, PMI (the two major funders) and the NMCP was, and is, key to this process. We have yet to receive confirmation of net gap which is why we have not as yet committed funds for nets. In part, this is due to the NMCP being required by the Global Fund (rightly in our view) to re-tender a particular element of the net distribution campaign and that has taken priority over work to finalise numbers. As with us, this has halted Global Fund money for nets until all is resolved satisfactorily. I also believe in part it is due to the NMCP having estimates and now they are being quizzed by us and others, they are having to think what to do – admit they are estimates (which we don’t necessarily have a problem with but we have asked to see the assumptions and logic behind those estimates) and/or because they are now coming round to the viewpoint (which we hold) that given the number of perfectly usable nets in place being above 15% of nets needed country-wide, it is economic and has other benefits, to conduct household by household surveys to determine exactly where (on a household basis) nets are needed. I can run through the $9m (cost of nets saved) vs $2-3m (cost of surveys country-wide) economic argument later."Rob Mather, Against Malaria Foundation Founder, email to GiveWell, August 6, 2011.
"Malawi...LLIN gap: 2.7 million w/o taking into account any existing LLINs, or 1.5 million if the nets they assume are there are accounted for during HH registration." Alliance for Malaria Prevention Conference call minutes (October 26, 2011) Pg 19.
As of November 2011, the Alliance for Malaria Prevention had posted minutes from its conference calls since August 3, 2011 at Alliance for Malaria Prevention Conference call minutes
"We liaise with a variety of sources including the Global Fund, in-country NGOs such as the Presidents Malaria Initiative, World Vision, UNICEF, Plan International, Concern Universal, and the relevant NMCP to establish a) who has been the source of the AMP estimate; b) how has it been arrived at; and c) what is the level of confidence of these groups it is accurate. We view this information as interesting and necessary but not sufficient for us to allocate nets." Rob Mather, Against Malaria Foundation Founder, email to GiveWell, August 8, 2012.
"We will typically approach the NMCP (National Malaria Control Program) directly and a) ask if there is a gap; b) ask for data on i) the population, number of nets required, number of nets previously distributed, number of nets considered to still be ‘usable nets’, number of nets required to achieve universal coverage (and all of the above on a regional/district basis) and ii) data on existing funding commitments so we can see who else is funding nets and at what level." Rob Mather, Against Malaria Foundation Founder, email to GiveWell, June 29, 2011.
Data in Against Malaria Foundation Malawi universal coverage calculations (September 26, 2011). In addition, AMF provided the email correspondence it had with the Malawi National Malaria Control Program, which involved extensive back-and-forth about the sources of the data and the assumptions used in the estimates of net needs.
Against Malaria Foundation LLIN distribution proposal form. For the Malawi distribution proposal, see Concern Universal Distribution proposal for Ntcheu district (October 2011-February 2012).
"Malaria case rate data, pre and post‐distribution: This information is crucial to being able to monitor the impact of the nets over time. We ask for the following information and confirmations: a) Please provide 12 months historic monthly malaria case rate information for each health clinic in the intended distribution area b) Please indicate for each health centre if this malaria data is via Rapid Diagnostic Testing Kit (RDTK) analysis or via clinical observation c) Please indicate if there is a plan to ensure each health centre will always have an adequate stock of RDTKs to ensure malaria case rate information can be continually gathered? d) Please confirm you will be able to gather and provide that information for the next four years?” Against Malaria Foundation How we work with distribution partners Pg 3.
"Post‐Distribution Surveys (PDSs): These occur 6, 18, 30 and 42 months after a distribution. They assess three things: 1. Hang‐up % ‐ are the nets still being used? 2. Correct usage – are the nets being used properly? 3. Net condition – in what state are the nets? A 6‐months Post‐Distribution Survey (PDS‐6) involves sampling 50 households per sub‐distribution location for the above information. The PDS‐6 must be carried out between months 5 and 7 post the initial distribution. Similarly for subsequent annual PDSs. The PDS form is shown below.” Against Malaria Foundation How we work with distribution partners Pg 3 and Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 20, 2012.
"7,646 randomly selected households were visited and 15,735 nets surveyed (6% of the nets distributed) across the 37 health centre catchment areas.” Against Malaria Foundation Concern Universal, Ntcheu, Malawi Distribution.
"Creating a source of funds for non-net costs might have benefit in allowing distributions to happen more quickly if there are no obvious or quick sources of funds for a potential distribution partner.
I have three reasons for hesitating. First, to what extent would it compromise or make unclear our focus and message that ‘100% buys nets’? Second, would non-net costs rise as we are less well placed to evaluate what costs are reasonable? Third, would distribution partner performance be affected negatively as they would no longer have their own funds invested in a net distribution?
It is worth noting we have always had non-net costs found, and quickly, by the distribution partner. However, we are now talking about larger distributions with greater associated non-net costs and this may change the speed at which non-net costs can be found." Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 16, 2012.
"For the subsequent verification visits (which Givewell witnessed) HSAs don't go into every household- instead they call a village register at a central location to check with the village leaders and individuals as to whether the data from the house to house survey is accurate. Givewell suggested that we should be doing some randomised checks on individual households at this verification stage- we have agreed and have now incorporated these into our verification model." Robin Todd, Concern Universal Malawi Director, email to Rob Mather, November 18, 2011.
"In 2010, Senegal and Cross River State in Nigeria worked on mop-up campaigns following earlier integrated campaigns targeting households with children under five years of age. In both countries, trained health workers or volunteers undertook a household registration to determine:
Both countries had previously undertaken post-distribution surveys which showed high household coverage with LLINs, but during the mop-up exercise they experienced challenges with finding nets in households. Significantly lower numbers of nets were found (50—60 per cent) than would have been expected based on the surveys...
In both countries, it seemed that families often hid nets once word spread that ownership of nets meant no new nets would be received. Despite efforts to encourage families to hang pre-existing nets prior to the household registration in Senegal, people hid nets in order to receive more." Alliance for Malaria Prevention Toolkit (version 2.0) - Chapter 3, Pgs 5-6.
“AMF has provided regular, public updates on the large, ongoing net distribution in the Ntcheu district of Malawi. Expected data collection has occurred and the distribution has proceeded close to schedule. AMF's distribution partner, Concern Universal, has been transparent about problems it has encountered, and seems to have a robust process to catch problems (such as attempts to steal nets) when they arise.” GiveWell AMF Update (March 2012)
AMF lists the countries it has provided nets to at Against Malaria Foundation Countries involved. The Malaria Atlas Project has compiled data on malaria risk by location at Malaria Atlas Project Endemic countries.
"Figures from Ntcheu District Hospital show that, in the twelve months to July 2011, 109,972 malaria cases were reported in under five children with a further 133,768 cases reported in the rest of the population." Concern Universal Distribution proposal for Ntcheu district (October 2011-February 2012) Pg 1.
"7,646 randomly selected households were visited and 15,735 nets surveyed (6% of the nets distributed) across the 37 health centre catchment areas." Against Malaria Foundation Concern Universal, Ntcheu, Malawi Distribution.
Exact net figure from Rob Mather, Against Malaria Foundation Founder, email to GiveWell, November 20, 2012.
"Health Surveillance Assistants (HSAs) are Government extension workers- they are the lowest tier of government presence in the decentralized health system." Robin Todd, Concern Universal Malawi Director, email to GiveWell, April 27, 2012.
"As such they are the first line of response to any public health issues in communities. Their job involves disseminating health related information (such as encouraging people to make use of sanitary facilities, go for immunizations, sleep under mosquito nets etc.), carrying out sanitation and hygiene campaigns and sending data on take-up of facilities to the District Council, conducting basic nutrition support, weighing children and reporting levels of stunting and wasting, detecting common communicable diseases and reporting these to clinicians and other health providers, implementing immunization campaigns etc. As you can see being involved in universal net distribution fits very well with their core public health responsibilities. HSAs need to have a primary school completion certificate as a minimum but the majority of them will have O-Levels (exams sat by pupils aged 16 if they have completed the school system at the recommended pace). Once they have been selected as HSAs they are sent on an initial 9 months intensive training course where they will be trained in many aspects of public health including how to recognize common diseases, how to administer immunizations etc." Robin Todd, Concern Universal Malawi Director, email to GiveWell, April 27, 2012.
See this spreadsheet.
See this spreadsheet.